Many people are concerned about their breasts. Fortunately the majority of our patients leave knowing that their problems are not serious. However, we recommend that you examine yourself regularly and seek advice if you notice anything new. In particular, you should ask for advice if you notice the following
Lump in the breast
Whilst most people will be very worried after finding a breast lump, fortunately the majority of breast lumps prove to be benign, rather than breast cancer. The common benign breast lumps include fibroadenomas (a normal variant also known as a "breast mouse" as it is very mobile in the breast), cysts (small bubbles associated with the milk ducts and filled with watery fluid) and fibrocystic change (where an area of breast tissue is rather lumpy). Rarely a lump can be found after an injury to the breast (fat necrosis) or when there is infection (mastitis).
Dimpling/distortion of the breast
When examining oneself, it is best to look down at the breasts and also in the mirror. It helps to do this with the arms down by the side and then with the arms raised. One is looking for a dimple or change in shape. Whilst this symptom can be associated with breast cancer, it can also be seen for benign reasons. When the breast changes dramatically (e.g. after breast feeding or during/after the menopause), one can sometimes see a subtle dimple related to natural shrinkage of the breast tissue. However, we would always urge people to see a doctor if dimpling is seen.
Nipple discharge is a relatively common condition. Sometimes it can be associated with breast cancer, but often it is an innocent finding. The two commonest causes of nipple discharge are duct ectasia (a normal variant where the milk ducts become bloated with normal secretions) and an intraduct papilloma (an innocent warty growth inside the milk duct, which looks likes fingers of coral).
New nipple inversion
Long standing nipple inversion is quite common among the population. However, one is more concerned about recent changes in the nipple, where the nipple becomes flattened or inverted. This can sometimes be associated with an underlying cancer, although more commonly this is due to benign reasons. The most common cause is duct ectasia (as the bloated milk ducts can concertina and shorten, thus pulling the nipple inwards).
Breast pain or discomfort is the most common complaint raised by patients about their breasts. It is rarely associated with breast cancer. Common causes include hormonal breast pain, rib/rib cartilage pain (costochondritis), chest wall muscle problems, shoulder and neck arthritis.
Swelling of the breast tissue in men
Generalised swelling of the breast (gynaecomastia) is a common problem in teenagers and older men. This is often hormonal in nature. Other common causes of this include liver problems (e.g. alcohol), drug abuse (particularly anabolic steroids and marijuana), other hormonal problems (e.g. excessive prolactin production), testicular problems and common medications (such as digoxin, spironolactone, cimetidine etc).
Breast cancer is occasionally seen in men. Male breast cancer is about 200 times less common than in women. This is rare in men under the age of 40 and increases slightly in frequency with advancing age. It presents in a similar way to female breast cancer, often with a painless lump or a change in the nipple.
Lumps in the armpit
It is quite common for normal women to have some excess breast tissue in the armpit; this is called accessory breast tissue. This can swell and change with pregnancy and other hormonal changes in a similar fashion to the rest of the breast. After pregnancy or the menopause, one can sometimes be left with some prominent fatty tissue in the armpit.
Normal lymph glands are usually too small to be felt in the armpit (although one can sometimes feel normal glands in very slim women). Lymph glands enlarge most commonly in reposnse to infection or inflammation. The glands in the armpit respond to changes in the breast, arm and upper trunk. Hence the lymph glands in the armpit can swell temporarily in response to skin irritation (e.g. eczema/psoriasis) and skin damage (e.g. cuts/bites). However, lymph glands can also become enlarged when involved with cancer (e.g. breast cancer, melanoma of the skin, and lymphoma).
Imperial Medical Group
Nuffield Health Cheltenham Hospital
Cheltenham GL51 6SY
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